Totonchi Ali, Guyuron Bahman
Cleveland (Lyndhurst), Ohio From the Department of Plastic Surgery, Case Western Reserve University.
Plast Reconstr Surg. 2007 Jul;120(1):271-274. doi: 10.1097/01.prs.0000264397.80585.bd.
Both arnica and corticosteroids have been suggested for reducing the postoperative edema and bruising associated with rhinoplasty. This study compared the efficacy of these products following rhinoplasty.
Forty-eight primary rhinoplasty patients were randomized into three groups: group P received 10 mg of dexamethasone (intravenously) intraoperatively followed by a 6-day oral tapering dose of methyl-prednisone; group A received arnica three times a day for 4 days; and group C received neither agent and served as the control. Three blinded panelists rated the extent of ecchymosis, the intensity of the ecchymosis, and the severity of the edema.
On postoperative day 2, there were no significant differences in the ratings of extent and intensity of ecchymosis among the groups. There was a significant difference for the edema rating (p < 0.0001), with group C demonstrating more swelling compared with groups A and P. In addition, on postoperative day 8, group P demonstrated a significantly larger extent of ecchymosis (p < 0.05) and higher intensity of ecchymosis (p < 0.01) compared with groups A and C. There were no differences in the magnitude of edema by postoperative day 8 among the three groups. When the differences between day 2 and day 8 ratings were considered, groups A and C exhibited significantly more resolution of ecchymosis by day 8 compared with group P (p < 0.05).
This study suggests that both arnica and corticosteroids may be effective in reducing edema during the early postoperative period. Arnica does not appear to provide any benefit with regard to extent and intensity of ecchymosis. The delay in resolution of ecchymosis for patients receiving corticosteroids may outweigh the benefit of reducing edema during the early postoperative period.
山金车属植物和皮质类固醇均被建议用于减轻隆鼻术后的水肿和瘀伤。本研究比较了这些产品在隆鼻术后的疗效。
48例初次隆鼻患者被随机分为三组：P组术中静脉注射10mg地塞米松，随后口服6天逐渐减量的甲基泼尼松；A组每天服用三次山金车属植物，共4天；C组不使用任何一种药物，作为对照组。三名盲法小组成员对瘀斑范围、瘀斑强度和水肿严重程度进行评分。
术后第2天，各组间瘀斑范围和强度的评分无显著差异。水肿评分有显著差异（p<0.0001），C组与A组和P组相比肿胀更明显。此外，术后第8天，P组与A组和C组相比，瘀斑范围显著更大（p<0.05），瘀斑强度更高（p<0.01）。三组术后第8天水肿程度无差异。当考虑第2天和第8天评分的差异时，A组和C组与P组相比，到第8天瘀斑消退更明显（p<0.05）。
本研究表明，山金车属植物和皮质类固醇在术后早期减轻水肿方面可能均有效。山金车属植物在瘀斑范围和强度方面似乎没有任何益处。接受皮质类固醇治疗的患者瘀斑消退延迟可能超过术后早期减轻水肿的益处。
